The effects of psychosocial aftercare following pediatric chronic pain treatment withstand the coronavirus disease 2019 pandemic: long-term outcomes of a randomized controlled trial.
Lisa-Marie Rau, Meltem Dogan, Gerrit Hirschfeld, Markus Blankenburg, Michael C Frühwald, Rosemarie Ahnert, Sarah Braun, Ursula Marschall, Boris Zernikow, Julia Wager
Author Information
Lisa-Marie Rau: German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Datteln, Germany. ORCID
Meltem Dogan: German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Datteln, Germany.
Gerrit Hirschfeld: Faculty of Business, University of Applied Sciences and Art Bielefeld, Bielefeld, Germany.
Markus Blankenburg: Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany.
Michael C Frühwald: Pediatrics and Adolescent Medicine, Bavarian Children's Pain Center, University Hospital Augsburg, Germany.
Rosemarie Ahnert: Pediatrics and Adolescent Medicine, Bavarian Children's Pain Center, University Hospital Augsburg, Germany.
Sarah Braun: Paediatric Pain Centre Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany.
Ursula Marschall: Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany.
Boris Zernikow: German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Datteln, Germany.
Julia Wager: German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Datteln, Germany. ORCID
Introduction: Intensive interdisciplinary pain treatment (IIPT) is the best therapy available for children and adolescents affected by severe chronic pain. Psychosocial aftercare (PAC) offered for 6 months after IIPT can improve treatment outcomes for up to 12 months. Objectives: The current study is the first to explore whether PAC is superior to treatment as usual at a long-term follow-up of 18 to 33 months after discharge-including when facing the coronavirus disease 2019 (COVID-19) pandemic. Methods: A multicenter randomized controlled trial investigated the impact of PAC with follow-up assessments in 2021 during the COVID-19 pandemic (N = 209). Multilevel models and regression analyses explored long-term treatment effects on pain characteristics and psychological outcomes, associations of pandemic-related burden with these outcomes, and whether pandemic-related burden moderates those effects. Results: Patients who received PAC significantly improved treatment outcomes concerning pain characteristics and psychological well-being 18 to 33 months after IIPT discharge. A COVID-19 infection among family members or peers was associated with a lower probability of having chronic pain at long-term follow-up, whereas having missed or rescheduled health care appointments was associated with a higher probability. Positive evaluations of family time during the pandemic were associated with better psychological well-being. Regardless of pandemic-related burdens, PAC had similarly better outcomes than treatment as usual. Only for anxiety, greater burdens mitigated the advantages of PAC. Conclusion: Despite adverse circumstances, PAC retained its superiority long-term. Integrating PAC into routine health care to support families after IIPT should be prioritized to yield enduring treatment effects, acting as a buffer against the impacts of unpredictable adverse events.
